Article

Migration Status in Relation to Clinical Characteristics and Barriers to Care Among Youth with Diabetes in the US

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Abstract

Migration status and the accompanying diversity in culture, foods and family norms, may be an important consideration for practitioners providing individualized care to treat and prevent complications among youth with diabetes. Approximately 20 % of youth in the US have ≥1 foreign-born parent. However, the proportion and characteristics of youth with diabetes and ≥1 foreign-born parent have yet to be described. Study participants (n = 3,086) were from SEARCH for Diabetes in Youth, a prospective multi-center study in the US. Primary outcomes of interest included HbA1c, body mass index and barriers to care. Multivariable analyses were carried out using logistic regression and analysis of covariance. Approximately 17 % of participants with type 1 diabetes (T1D) and 22 % with type 2 diabetes (T2D) had ≥1 foreign-born parent. Youth with T1D and ≥1 foreign-born parent were less likely to have poor glycemic control [adjusted odds ratio (OR) (95 % confidence interval): 0.70 (0.53, 0.94)]. Among youth with T2D, those with ≥1 foreign-born parent had lower odds of obesity [adjusted OR (95 % CI): 0.35 (0.17, 0.70)]. This is the first study to estimate the proportion and characteristics of youth with diabetes exposed to migration in the US. Research into potential mechanisms underlying the observed protective effects is warranted.

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... Esta actitud positiva hacia el autocuidado también se observa en lo descrito por , quienes señalaron un mayor uso de servicios de atención prenatal y ginecológica en la población migrante, comparado con la chilena, lo cual debería ser considerado por los equipos sanitarios para fomentar en ellos -y en la comunidad en general-conductas preventivas. En estudios realizados en población inmigrante en Estados Unidos, estas poblaciones presentan menos riesgo de diabetes en jóvenes y menos riesgo de ITS en mujeres latinas (Jaacks, L. M. et al., 2012;Ojeda et al., 2009). Es posible que el hecho de sentirse con menor acceso a la atención sanitaria les lleve a tener una actitud positiva de autocuidado. ...
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... 49 Previous studies have shown that the migration status of parents is associated with glycemic control among youth with T1D. 50 To address potential differences, we examined a subset of the sample with data on parental nativity (ie, US born vs foreign born) and found no significant differences across HbA 1c trajectory groups. Adjustment for parental nativity did not attenuate the association of black race or Hispanic ethnicity with the moderate or highest HbA 1c trajectory group, although the analysis is limited by small sample size (data not shown). ...
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Several major demographic shifts over the past half-century have transformed who we are and how we live in this country in many ways. Most striking, however, is the fact that children today are much more likely to be members of ethnic or racial minority groups. Racial/ethnic minorities are destined, in aggregate, to become the numerical majority within the next few decades. This article presents a wide range of statistics reflecting cultural, family, social, economic, and housing circumstances across various racial/ethnic and country-of-origin groups. Key observations include: Right Half Block Cirlce Sign Children in immigrant families are much less likely than children in native-born families to have only one parent in the home, and they are nearly twice as likely as those in nativeborn families to be living with grandparents, other relatives, and non-relatives. Right Half Block Cirlce Sign Parental educational attainment is perhaps the most central feature of family circumstances relevant to overall child well-being and development, regardless of race/ethnicity or immigrant origins. Right Half Block Cirlce Sign Children in immigrant families were only slightly less likely than children in nativeborn families to have a father who worked during the past year, but many of their fathers worked less than full-time year-round. Right Half Block Cirlce Sign Official poverty rates for children in immigrant families are substantially higher than for children in native-born families (21% versus 14%). The author concludes that these results point to a growing need for policies and programs to assure the health, educational success, and well-being of all children across the varied racial/ethnic and immigrant-origin groups who now live in this country.
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The etiology and natural history of T1DM are still unknown but certainly both genetics and environmental factors contribute to the development of the disease. Migration studies are an important tool to better understand the role of the environment. The aim of this study was to investigate some variables in diabetic children of immigrant families living in Emilia-Romagna compared with Italian diabetic children living in the same region. We recruited 73 diabetic children from immigrant families and 707 Italian diabetic children. All children were cared by Pediatric Diabetes Units of Emilia-Romagna (10 centers). The investigated variables were: gender, current age, place of birth, parents' country of origin, age at diagnosis, HbA1c and insulin regimen. No significant difference with reference to gender neither among the two ethnic groups, nor in the current mean age was observed. Mean age at diagnosis in the Italian children was lower than in immigrant patients born outside Italy--group A- (7.4 vs. 9.6, p < 0.000) and higher compared to those born in Italy--group B- (7.4 vs. 5.7 p < 0.003; A vs. B p < 0.000). The immigrant patients showed higher mean HbA1c than Italian patients (8.8 vs. 8.2, p < 0.009). A younger age at diagnosis of T1DM in immigrant children, born in Italy compared with those born in the country of origin, and with Italian patients, suggests the existence of some environmental determinants acquired with a more westernised lifestyle. Immigrant children have significantly poorer metabolic control compared with western patients. (www.actabiomedica.it)
Article
Although at arrival, US immigrants have a lower prevalence of overweight compared to native born individuals, prevalence increases with increased length of residence. It is unknown whether length of residence similarly affects diabetes. Data on adults aged 18-74 years from the National Health Interview Survey were pooled from 1997 to 2005 (n = 33,499). Diabetes prevalence by length of residence was estimated by multivariable logistic regression. Diabetes prevalence was higher with increased length of residence in the US, independent of age and body mass index (<5 years residence: 3.3%; 5-<10 year, 3.4%; 10-<15 year, 4.5%; 15+ year, 5.3%; P for trend <0.001). Length of residence had the largest effect on diabetes prevalence among immigrants who arrive at 25-44 years of age (prevalence: 1.4% for <5 year vs. 11.1% for 15+ year; odds ratio = 9.7 (95% CI: 5.2-18.1)). Despite differences in the associations between diabetes prevalence and length of residence by age at immigration, diabetes prevalence at 10-≤15 and 15± years was statistically similar in each age at immigration strata. Diabetes prevalence increased with length of residence, independent of age and obesity, and was modified by age at immigration. Diabetes prevalence reaches a plateau at 10+ years of residence and diabetes prevention efforts should, therefore, start soon after migration.
Article
To assess correlates of glycemic control in a diverse population of children and youth with diabetes. This was a cross-sectional analysis of data from a 6-center US study of diabetes in youth, including 3947 individuals with type 1 diabetes (T1D) and 552 with type 2 diabetes (T2D), using hemoglobin A(1c) (HbA(1c)) levels to assess glycemic control. HbA(1c) levels reflecting poor glycemic control (HbA(1c) >or= 9.5%) were found in 17% of youth with T1D and in 27% of those with T2D. African-American, American Indian, Hispanic, and Asian/Pacific Islander youth with T1D were significantly more likely to have higher HbA(1c) levels compared with non-Hispanic white youth (with respective rates for poor glycemic control of 36%, 52%, 27%, and 26% vs 12%). Similarly poor control in these 4 racial/ethnic groups was found in youth with T2D. Longer duration of diabetes was significantly associated with poorer glycemic control in youth with T1D and T2D. The high percentage of US youth with HbA(1c) levels above the target value and with poor glycemic control indicates an urgent need for effective treatment strategies to improve metabolic status in youth with diabetes.
Article
We estimated the prevalence of overweight and diabetes among US immigrants by region of birth. We analyzed data on 34 456 US immigrant adults from the National Health Interview Survey, pooling years 1997 to 2005. We estimated age- and gender-adjusted and multivariable-adjusted overweight and diabetes prevalence by region of birth using logistic regression. Both men (odds ratio [OR] = 3.3; 95% confidence interval [CI] = 1.9, 5.8) and women (OR = 4.2; 95% CI = 2.3, 7.7) from the Indian subcontinent were more likely than were European migrants to have diabetes without corresponding increased risk of being overweight. Men and women from Mexico, Central America, or the Caribbean were more likely to be overweight (men: OR = 1.5; 95% CI = 1.3, 1.7; women: OR = 2.0; 95% CI = 1.7, 2.2) and to have diabetes (men: OR = 2.0; 95% CI = 1.4, 2.9; women: OR = 2.0; 95% CI = 1.4, 2.8) than were European migrants. Considerable heterogeneity in both prevalence of overweight and diabetes by region of birth highlights the importance of making this distinction among US immigrants to better identify subgroups with higher risks of these conditions.
Article
To assess whether family involvement and acculturation were related to adherence and glycemic control among Hispanic youth with type 1 diabetes (T1D). Hispanic youth with T1D (n = 111; M age = 13.33; 53% female) and parents completed questionnaires that assessed diabetes-related family involvement (distribution of responsibility for diabetes, family support for diabetes), acculturation (linguistic acculturation, generational status), and adherence. HbA1c levels indexed glycemic control. Better adherence was associated with less adolescent independent responsibility, more family support for diabetes, and more recent immigration (fewer generations of the family living in US). Family support mediated the relationship between responsibility and adherence. Better glycemic control was associated with higher levels of parental education and adherence. Family support for diabetes is important for adherence among Hispanic youth with T1D. Research should examine aspects of recent immigration that contribute to better adherence and the impact of supportive interventions on diabetes care.
Article
The growing size and changing composition of the foreign-born population in the USA highlights the importance of examining the health consequences of living in neighborhoods with higher proportions of immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in four US cities, we examined whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) among Hispanic and Chinese Americans (n=1902). Secondarily we tested whether neighborhoods with high proportions of immigrants exhibited better or worse neighborhood quality, and whether these dimensions of neighborhood quality were associated with healthy behaviors. Neighborhood immigrant composition was defined based on the Census 2000 tract percent of foreign-born from Latin-America, and separately, percent foreign-born from China. After adjustment for age, gender, income, education, neighborhood poverty, and acculturation, living in a tract with a higher proportion of immigrants was associated with lower consumption of high-fat foods among Hispanics and Chinese, but with being less physically active among Hispanics. Residents in neighborhoods with higher proportions of immigrants reported better healthy food availability, but also worse walkability, fewer recreational exercise resources, worse safety, lower social cohesion, and lower neighborhood-based civic engagement. Associations of neighborhood immigrant composition with diet persisted after adjustment for reported neighborhood characteristics, and associations with physical activity were attenuated. Respondent-reported neighborhood healthy food availability, walkability, availability of exercise facilities and civic participation remained associated with behaviors after adjusting for immigrant composition and other covariates. Results show that living in an immigrant enclave is not monolithically beneficial and may have different associations with different health behaviors.
Article
The migration of Tokelauans from a traditional atoll in the Pacific to urban New Zealand is associated with an increased prevalence and incidence of Type 2 (non-insulin-dependent) diabetes mellitus over the period 1968-1982. During the same period, a lesser but definite increase is seen among non-migrants in Tokelau. The age standardised prevalence rates rose from 7.5 and 11.7 to 10.8 and 19.9 per 100 respectively in the male and female migrants compared with an increase from 3.0 and 8.7 to 7.0 and 14.3 per 100 in the non-migrant males and females respectively. The incidence of diabetes is shown to be consistently higher in the migrants compared to the non-migrants giving relative risks of 1.5 in males and 1.9 in females. The factors most likely contributing to this difference, are changes to a higher calorie, high protein diet, higher alcohol consumption, a greater weight gain and altered levels of physical activity in the migrants. A number of populations in the Pacific have been shown to have a low rate of diabetes in their traditional setting, but may have a genetic predisposition for diabetes which responds to factors in the urban industrialised environment and life-style. The social and economic changes taking place in Tokelau are also clearly increasing the risk of diabetes. To reverse these trends and prevent the development of complications of Type 2 diabetes, it will be important to institute preventive programmes and to follow up the population in both environments for long-term outcomes, including mortality.
Article
Causal diagrams have a long history of informal use and, more recently, have undergone formal development for applications in expert systems and robotics. We provide an introduction to these developments and their use in epidemiologic research. Causal diagrams can provide a starting point for identifying variables that must be measured and controlled to obtain unconfounded effect estimates. They also provide a method for critical evaluation of traditional epidemiologic criteria for confounding. In particular, they reveal certain heretofore unnoticed shortcomings of those criteria when used in considering multiple potential confounders. We show how to modify the traditional criteria to correct those shortcomings.
Article
This study analyzes data from seventy-nine focus groups conducted in the Philippines, Singapore, Taiwan, and Thailand. The research examined ways in which respect for the elderly is experienced in these four countries, the extent to which respect has changed over time, and the reasons for changes in respect for the elderly. Using qualitative analysis, five distinct dimensions of respect were identified: gestures and manners, tokens, customs and rituals, asking for advice, and obedience. Focus group discussions indicated that changes have occurred on most of these dimensions of respect. The changes were attributed to variations in family structure and function, education, income, and modernization. These findings are discussed in relation to changing definitions of respect and variations in the way in which respect for the elderly is expressed in Asia.
Article
Although Filipino Americans are projected to become the largest Asian American ethnic group in this millennium, no acculturation measure existed for this group. This article describes a systematic and replicable process used in adapting and modifying A Short Acculturation Scale for Hispanics (ASASH) for use with Filipino Americans. It depicts the multiple and iterative steps of translation and backtranslation to produce A Short Acculturation Scale for Filipino Americans (ASASFA) in English and in Tagalog--the Philippine national language. Also, it describes the methods undertaken for the measures to achieve linguistic and cross-cultural validity through content, technical, experiential, semantic, and conceptual equivalence. With the dearth of linguistically and culturally valid measures for immigrant populations, the adaptation of valid measures developed for other cultures remains a viable option.
Article
Our goal was to estimate the prevalence of diabetes mellitus in youth <20 years of age in 2001 in the United States, according to age, gender, race/ethnicity, and diabetes type. The SEARCH for Diabetes in Youth Study is a 6-center observational study conducting population-based ascertainment of physician-diagnosed diabetes in youth. Census-based denominators for 4 geographically based centers and enrollment data for 2 health plan-based centers were used to calculate prevalence. Age-, gender-, and racial/ethnic group-specific prevalence rates were multiplied by US population counts to estimate the total number of US youth with diabetes. We identified 6379 US youth with diabetes in 2001, in a population of approximately 3.5 million. Crude prevalence was estimated as 1.82 cases per 1000 youth, being much lower for youth 0 to 9 years of age (0.79 cases per 1000 youth) than for those 10 to 19 years of age (2.80 cases per 1000 youth). Non-Hispanic white youth had the highest prevalence (1.06 cases per 1000 youth) in the younger group. Among 10- to 19-year-old youth, black youth (3.22 cases per 1000 youth) and non-Hispanic white youth (3.18 cases per 1000 youth) had the highest rates, followed by American Indian youth (2.28 cases per 1000 youth), Hispanic youth (2.18 cases per 1000 youth), and Asian/Pacific Islander youth (1.34 cases per 1000 youth). Among younger children, type 1 diabetes accounted for > or = 80% of diabetes; among older youth, the proportion of type 2 diabetes ranged from 6% (0.19 cases per 1000 youth for non-Hispanic white youth) to 76% (1.74 cases per 1000 youth for American Indian youth). We estimated that 154,369 youth had physician-diagnosed diabetes in 2001 in the United States. The overall prevalence estimate for diabetes in children and adolescents was approximately 0.18%. Type 2 diabetes was found in all racial/ethnic groups but generally was less common than type 1, except in American Indian youth.
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